Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Is IV NTG Too Dangerous for EMS

We all know just how dangerous NTG (NiTroGlycerin) can be for hypotensive patients. My protocols prohibit use when the BP (Blood Pressure) is less than 100 systolic. What would happen if someone gave IV NTG to a hypotensive patient with CHF/ADHF (Congestive Heart Failure/Acute Decompensated Heart Failure)?

Certain Death!


So how dangerous is IV NTG with a low BP?

Patients with systolic blood pressure less than 100 mm Hg represented the subset with the most significant reduction in mortality: 31.8% versus 59.4% (OR, .32; 95% CI, .2 to .5) (Table 6).[1]

Click on the images to make them larger.

The thing we are supposed to be most worried about giving NTG to has its death rate cut in half.

We need to stop letting our fear kill our patients.


[1] Intravenous nitrates in the prehospital management of acute pulmonary edema.
Bertini G, Giglioli C, Biggeri A, Margheri M, Simonetti I, Sica ML, Russo L, Gensini G.
Ann Emerg Med. 1997 Oct;30(4):493-9.
PMID: 9326864 [PubMed – indexed for MEDLINE]